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General NPI Number Information
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NPI Number | 1700345683
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Entity Type | Individual
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Provider Name | KEVIN HYNES LMFT
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Gender |
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 12 LONG LAKE RD STE 16
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City | MAHTOMEDI
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State | MN
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Zip | 55115-1200
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Country | US
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Telephone | 872-240-2427
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Fax |
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Provider Business Mailing Address
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Address Line | 12 LONG LAKE RD STE 16
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City | MAHTOMEDI
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State | MN
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Zip | 55115-1200
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Country | US
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Telephone | 860-892-7042
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4554
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.001414
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35002075A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2073
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License Number State | CT
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